未受影响的运动皮质早期去抑制是否能预测中风后的运动恢复?

IF 8.9 1区 医学 Q1 CLINICAL NEUROLOGY
Stroke Pub Date : 2025-10-01 Epub Date: 2025-07-22 DOI:10.1161/STROKEAHA.125.051614
Charlotte Rosso, Lina Daghsen, Justine Bouvier, Thomas Checkouri, Sarah Millot, Flore Baronnet, Damien Galanaud, Romain Valabregue, Pierre Pouget, Jean-Charles Lamy, Emmanuel Roze
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引用次数: 0

摘要

背景:脑卒中后未受影响半球的皮质内抑制是否与运动恢复有关可能取决于受影响半球的皮质脊髓兴奋性状态。目的是:(1)根据患者的运动诱发电位(MEP)状态,确定急性期存在短潜伏期皮质内抑制(SICI);(2)在患者亚组(有或没有MEP)中,未受影响的半球SICI是否与3个月时的运动恢复相关。方法:纳入95例脑卒中患者(中位年龄68岁;四分位数范围61-78岁,性别:61%男性,n=58),上肢无力持续第3天,分析83例患者(中位年龄67岁;在这个单中心研究中(从2022年8月到2024年5月),四分位数范围,59-77岁,性别:65%男性,n=54)。在第7天之前进行经颅磁刺激以确定MEP的存在并记录两脑半球的SICI。第7天采用Fugl-Meyer上肢评估进行运动评估,3个月时采用Fugl-Meyer上肢评估和动作研究臂测试进行运动评估。结果:58%的MEP患者在未受影响的半球存在SICI(第一背骨间未出现MEP的患者;n=14/24)和57%的MEP+患者(第一背骨间可溯性MEP患者;N =33/ 57,2个缺失数据)。MEP-患者(而非MEP+患者)未受影响半球SICI的存在与更好的运动恢复相关(Spearman秩系数,-0.514 [95% CI, -0.774至-0.106];P=0.017),与第7天的Fugl-Meyer上肢评估(R²=54%,P=0.002)一起,在逐步多元线性回归中是运动恢复的独立预测因子。结论:在未来的研究中,实施皮质内抑制可以改善无MEP的严重患者的预测模型,这些患者的康复轨迹难以预测,临床康复决策也难以做出。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Could the Early Disinhibition of the Unaffected Motor Cortex Predict Motor Recovery After Stroke?

Background: Whether intracortical inhibition in the unaffected hemisphere is related to motor recovery after stroke may depend on the status of corticospinal excitability in the affected hemisphere. The aims are (1) to identify the presence of short-latency intracortical inhibition (SICI) in the acute phase according to the motor-evoked potential (MEP) status of the patients and (2) to investigate whether unaffected hemisphere SICI is associated with motor recovery at 3 months in subgroups of patients (with or without an MEP).

Methods: We enrolled 95 patients with stroke (median age, 68 years; interquartile range, 61-78 years, sex: 61% males, n=58) with upper extremity weakness persistent on day 3 and analyzed 83 patients (median age, 67 years; interquartile range, 59-77 years, sex: 65% males, n=54) in this single-center study (from August 2022 to May 2024). Transcranial magnetic stimulation was performed before day 7 to determine the presence of MEP and to record SICI in both hemispheres. The motor evaluation was performed on day 7 using the Fugl-Meyer Assessment of the Upper Extremity and at 3 months by the Fugl-Meyer Assessment of the Upper Extremity and the Action Research Arm Test.

Results: SICI was present in the unaffected hemisphere in 58% of MEP- patients (patients with no evocable MEP in the first dorsal interosseous; n=14/24) and 57% of MEP+ patients (patients with evocable MEP in the first dorsal interosseous; n=33/57, 2 missing data). The presence of SICI in the unaffected hemisphere in MEP- patients (but not in MEP+) was associated with better motor recovery (Spearman rank coefficient, -0.514 [95% CI, -0.774 to -0.106]; P=0.017) and was an independent predictor of motor recovery on a stepwise multiple linear regression, along with the Fugl-Meyer Assessment of the Upper Extremity at day 7 (R²=54%, P=0.002).

Conclusions: Implementing intracortical inhibition could improve prediction models in future studies for severe patients without an MEP whose recovery trajectories are hard to predict and for whom clinical rehabilitation decisions are difficult to make.

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来源期刊
Stroke
Stroke 医学-临床神经学
CiteScore
13.40
自引率
6.00%
发文量
2021
审稿时长
3 months
期刊介绍: Stroke is a monthly publication that collates reports of clinical and basic investigation of any aspect of the cerebral circulation and its diseases. The publication covers a wide range of disciplines including anesthesiology, critical care medicine, epidemiology, internal medicine, neurology, neuro-ophthalmology, neuropathology, neuropsychology, neurosurgery, nuclear medicine, nursing, radiology, rehabilitation, speech pathology, vascular physiology, and vascular surgery. The audience of Stroke includes neurologists, basic scientists, cardiologists, vascular surgeons, internists, interventionalists, neurosurgeons, nurses, and physiatrists. Stroke is indexed in Biological Abstracts, BIOSIS, CAB Abstracts, Chemical Abstracts, CINAHL, Current Contents, Embase, MEDLINE, and Science Citation Index Expanded.
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